• Eleanor K Mishra, Sanjeevan Muruganandan, Allan Clark, Rahul Bhatnagar, Nick Maskell, LeeY C GaryYCGUniversity of Western Australia, Perth, Australia., and Najib M Rahman.
• Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, England; University of East Anglia, Norwich, Norfolk, England. Electronic address: eleanor.mishra@gmail.com.
• Chest. 2021 Jul 1; 160 (1): 351-357.

BackgroundPatients with malignant pleural effusions (MPEs) experience breathlessness and poor survival. Breathlessness is associated with poor survival in other conditions.Research QuestionIs breathlessness, measured using a visual analog scale for dyspnea (VASD), associated with survival in patients with MPE?Study Design And MethodsIndividual patient data from five randomized controlled trials of 553 patients undergoing interventions for MPE were analyzed. VASD was recorded at baseline and daily after intervention. Patients were followed up until death or end of trial. Univariate and multivariable Cox regression were used to identify factors associated with survival.ResultsBaseline VASD was significantly associated with worse survival, with a hazard ratio of 1.10 (95% CI, 1.06-1.15) for a 10-mm increase in VASD. On multivariable regression, it remained a significant predictor of survival. Mean 7-day VASD and mean total VASD were also predictors of survival (mean 7-day VASD: hazard ratio [HR], 1.26 [95% CI, 1.19-1.34]; total VASD: HR, 1.25 [95% CI, 1.15-1.37]). Other predictors of survival were serum C-reactive protein level and tumor type. Previous treatment with chemotherapy, performance status, pleural fluid lactate dehydrogenase, serum albumin, hemoglobin, serum neutrophil:lymphocyte ratio, and size of effusion were associated with survival on univariate but not multivariable analysis.InterpretationBreathlessness, measured using VASD at baseline and postprocedure, is a predictor of survival in patients with MPE.Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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